Coffee Break with Maria Todd 4/15/2014

I feel very fortunate to have such specialists to work with me as colleagues. My friend and colleague Suzanne Salimbene, PhD wrote “the book” on Culture and Language Sensitivity (CLAS) for HHS almost a decade ago. You can find some of her articles on this topic in her blog on our website. Just search for Salimbene in the search box.

Health Literacy in a Cultural Context

Recognizing that culture plays an important role in communication helps us better understand health literacy. For people from different cultural backgrounds, health literacy is affected by belief systems, communication styles, and understanding and response to health information. Even though culture is only one part of health literacy, it is a very important piece of the complicated topic of health literacy. The United States Department of Health and Human Services (HHS) recognizes that “culture affects how people communicate, understand and respond to health information.” (Health and Human Services Quick Guide to Health Literacy- Health Literacy Basics)

According to the American Medical Association report, Health Literacy and Patient Safety: Help Patients Understand, “poor health literacy is a stronger predictor of a person’s health than age, income, employment status, education level, and race”. I have an old copy of this, but it is no longer online, so sorry no convenient link to read it.

This is where Concierge Medicine is able to shine. The move toward “patient-centered” health care as part of an overall effort to improve the quality of health care and to reduce costs is at the core of the concierge medicine movement, not physicians disgruntled over reimbursement. In concierge medicine, patients and providers attempt to work together to ensure effective communication. But the patients need to take an active role in health related decisions. My impressions is that they don’t know how! They are unaccustomed to having that time and relationship with their physician and they don’t know how to get the most from a concierge medicine relationship. So doctors…. the first value you can provide for your new members is to give them a handbook of How to be a Concierge Medicine Member.

Next, remember the suggestion a few weeks back about a book you could give away to new patients? The $2.50 book? Why can’t that be a book you write called Your Body: An Owner’s Manual?

Health care providers also need to utilize effective health communication skills, including techniques such as “teach-back”. Health educators and providers and nurses and technicians and pharmacists, and medical assistants need to write printed and Web-based information using plain language.

Skills Needed for Health Literacy

Patients are often faced with complex information and treatment decisions. Some of the specific tasks patients are required to carry out may include:

• Evaluating information for credibility and quality
• Analyzing relative risks and benefits
• Calculating dosages
• Interpreting test results
• Locating health information
• Giving themselves injections

In order to accomplish these tasks, individuals may need to be:

• Visually literate (able to understand graphs or other visual information)
• Computer literate (able to operate a computer)
• Information literate (able to obtain and apply relevant information)
• Numerically or computationally literate (able to calculate or reason numerically).

Oral language skills are important as well. Patients need to articulate their health concerns and describe their symptoms accurately. But if they don’t know what parts of their bodies are called, how can they describe it over a phone? or an email? or a SMS text?

They need to ask pertinent questions, and they need to understand spoken medical advice or treatment directions. But if they are shy, or not used to taking that time with the doctor, they may figure, “don’t bother the doc, I’ll just go look it up when I get around to it.”

In an age of shared responsibility between physician and patient for health care, patients need strong decision-making skills. But how can they decide when they don’t know what they don’t know? With the development of the Internet as a source of health information, health literacy may also include the ability to search the Internet and evaluate Web sites. Many patients in concierge medicine are wired to the hilt. But the same physicianmay not realize that while the person has access to a computer, they don’t understand the -itis, -osis, -ectomy, -otomy world that we are used to speaking all day.

Economic Impact of Low Health Literacy

In addition to the effects of low health literacy on the individual patient, there are economic consequences of low health literacy to society. According to the report Low Health Literacy: Implications for National Health Policy “Low health literacy is a major source of economic inefficiency in the U.S. health care system.” The report estimates that the cost of low health literacy to the U.S. economy is between $106 billion to $238 billion annually. This represents between 7 percent and 17 percent of all personal health care expenditures. To put this in perspective, the cost represents an amount equal to the cost of insuring every one of the more than 47 million people who lacked coverage in the United States in 2006. Improving health communication reduces health care costs and increases the quality of health care. So why the heck didn’t they address health literacy instead of writing the gibberish of the ACA? And…chances are.. that some of the people on the committees writing the ACA may have been one in the same that nodded their heads to hide their own health illiteracy, because some the sh..crap in the ACA doesn’t make sense where human medicine is concerned!

Cup empty. More tomorrow!